Four years of civil war and genocide in Rwanda took the lives of almost 1 million people, leaving the country in a state of almost total collapse in 1994. While 60% of the population still lives below the poverty line, in only 16 years the country has made remarkable improvements on key health indicators, including: infant and child mortality; immunisation coverage; use of family planning; malaria mortality and morbidity; and HIV prevalence.

Progress can be attributed to ambitious reforms in the health sector, including the introduction of community health insurance and boosting of services through staff incentives and performance-based financing (PBF) schemes. Strong leadership, vision and commitment have also been key. Participatory decentralisation, including extensive use and formalisation of community health workers (CHWs), has brought services closer to communities and empowered them to participate in their own development. Meanwhile, effectively coordinated donor assistance has been instrumental in achieving such remarkable outcomes in the Rwandan health sector.